1/ There is a confusion between early vs advanced cancer & Superficial vs Deep Ca 👉 Early Ca-Invasion depth to submucosa only, irrespective of nodal status 👉 Advanced Ca- invasion beyond submucosa with regional nodes or distant metastasis #GITwitter #MedTwitter #Gastroresidents

2/ Superficial lesions- those that are believed to be endoscopically resectable Deep lesions- those that are deemed “too deep” to be scooped, and thus endoscopically unresectable #GIFellows #ACG #Tweetorial

3/ The decision for endoscopic resection is based on combination of morphological and advanced imaging appearance (NBI/Chromo) @giendo_roy High Risk for Submucosal Invasion 👎 Depressed lesion 👎 Kudo V pit pattern 👎 NICE 3 pattern 👎 Fold convergence 👎 Non-lifting sign

4/After endoscopic treatment, curative or non-curative resection is established based on histology Curative cut 👍Well or mod differentiated 👍Good lateral margins (>1mm) 👍Confined to superficial submucosa (<1mm)(Level3 in polypoid lesion) 👍No LV involvement 👍No tumor budding

5/There are numerous facts that we use reflexively when assessing the malignant potential of a polyp. At times, a single finding is enough to diagnose SM invasion. Other times, combination two or more findings needed for diagnosis. How we use these information in decision making

When assessing the potential for invasive cancer, because of our difficulty to combine the specificities of different findings, our decisions are skewed by heuristics and biases. To understand more on system thinking and overcoming biases, checkout

Endoscopic Assessment of the Malignant Potential of the Nonpolypoid (Flat and Depressed) Colorectal Neoplasms: Thinking Fast, and Slow - PubMed

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Current endoscopy training methodology does not meet the learning traits, skills, and needs of the newer generation o...

https://pubmed.ncbi.nlm.nih.gov/31445686/